ATI RN
Nursing Care of Children ATI
1. The clinic nurse is teaching parents about physiologic anemia that occurs in infants. What statement should the nurse include about the cause of physiologic anemia?
- A. Maternally derived iron stores are depleted in the first 2 months.
- B. Fetal hemoglobin results in a shortened survival of red blood cells.
- C. The production of adult hemoglobin decreases in the first year of life.
- D. Low levels of fetal hemoglobin depress the production of erythropoietin.
Correct answer: B
Rationale: Physiologic anemia is caused by the transition from fetal to adult hemoglobin, with fetal hemoglobin having a shorter lifespan, leading to a temporary decrease in red blood cells.
2. Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.)
- A. Disturbed concept of sexuality
- B. All are applicable
- C. Worry about themselves, parents, or siblings
- D. Expression of anger, sadness, shame, or embarrassment
Correct answer: B
Rationale: Adolescents may withdraw from social interactions, worry about the impact of the divorce, and express strong emotions such as anger or sadness.
3. The parents of an 8-month-old infant voice concern to the nurse that their infant is not developing motor skills as the infant should. What question would be appropriate for the nurse to ask in determining if their fears are warranted?
- A. Does the infant move a toy back and forth from one hand to the other?
- B. Is the infant able to drink from a cup by oneself?
- C. Is the infant able to hold a pencil and scribble on paper?
- D. Does the infant place toys into a box or container and take them out?
Correct answer: A
Rationale: The correct answer is A. By 8 months, an infant should be able to transfer objects between hands, which is an important motor skill milestone. This action shows coordination and developing fine motor skills. Choices B, C, and D involve more advanced motor skills that are typically not expected at 8 months of age. Drinking from a cup, holding a pencil to scribble, and engaging in purposeful play with toys are skills that develop later in infancy.
4. The parent of a 2-week-old infant asks the nurse if fluoride supplements are necessary because the infant is exclusively breastfed. What is the nurse's best response?
- A. The infant needs to begin taking them now.
- B. Supplements are not needed if you drink fluoridated water.
- C. The infant may need to begin taking them at age 6 months.
- D. The infant can have infant cereal mixed with fluoridated water instead of supplements.
Correct answer: C
Rationale: Breastfed infants may need fluoride supplements starting at 6 months if they are not receiving fluoride from other sources, such as drinking water.
5. What is the most appropriate action for a child with epistaxis?
- A. Have the child lie flat
- B. Pinch the nose and lean forward
- C. Apply a warm compress to the nose
- D. Encourage deep breathing
Correct answer: B
Rationale: The most appropriate action for a child with epistaxis is to pinch the nose and lean forward. This technique helps stop the bleeding and prevent aspiration of blood. By applying pressure to the bleeding vessels and allowing the blood to drain out of the nostrils instead of being swallowed, the risk of nausea and airway obstruction is reduced. Having the child lie flat (Choice A) may lead to blood flowing down the throat, causing potential choking. Applying a warm compress (Choice C) is not typically recommended for epistaxis as cold compresses are more effective. Encouraging deep breathing (Choice D) is not directly related to managing epistaxis.
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